Healthcare Provider Details

I. General information

NPI: 1508901836
Provider Name (Legal Business Name): ENID EYE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E OKLAHOMA AVE SUITE 101
ENID OK
73701-5951
US

IV. Provider business mailing address

615 E OKLAHOMA AVE SUITE 101
ENID OK
73701-5951
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-4711
  • Fax: 580-234-6686
Mailing address:
  • Phone: 580-233-4711
  • Fax: 580-234-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: JAMES R ROGERS
Title or Position: SURGEON
Credential: M.D.
Phone: 580-233-4711